INTERNISTS and thoracic surgeons often differ regarding the curability of lung cancer. While there is no question that resection is the only current cure, the magnitude of the surgical contribution to the overall conquest of lung cancer cannot be impressive when the five-year survival rate continues to be about 5%.1-3 Under such circumstances, many physicians whose professional relationships to their patients and their patients' families are on a continuing basis, have serious reservations as to the propriety of urging the expense and discomfort of thoracic surgery.
Evaluation of therapy requires that effectiveness be measured against a sound knowledge of the natural history of disease. Realizing how little is known about the natural history of lung cancer, we began the Philadelphia Pulmonary Neoplasm Research Project in 1951 to delineate the chronologic relationship of roentgenographic changes to symptoms, smoking habits, etc.
Over a four-year period from Dec 4, 1951, every